This is part of a series of posts from Sharon Wong, blogger at Nut Free Wok, reporting from the Food Allergy Research and Education Annual Conference.
Food Allergy Research and Education (FARE) hosts an annual conference for individuals, families, and professionals who are interested in food allergies. I spent a wonderful weekend in San Antonio at the FARE conference, April 28-30, 2017. Approximately 200 people were in attendance to “connect, inspire, and unite” around the topic of living with food allergies and anaphylaxis.
The FARECon lineup of expert speakers and topics was excellent and it was difficult to choose which session to attend among the different choices held at the same time. As a food allergy mother, I’d love to be able to know everything about food allergies – I just need about 10 clones of myself to get it done!
Please note that although these snippets of information are from top medical doctors, you should always consult a board certified allergist/doctor to manage your allergies.
One of the keynote speakers, Dr. Scott Sicherer, an M.D., professor, researcher, and allergist from Mt. Sinai and Jaffe Food Allergy Institute, spoke about Food Allergy Research and Treatment. He told the audience there is an increased interest in food allergy research over the past decade. Among the 2,000 articles published in 2016, he shared a few highlights:
- Using epinephrine to treat a severe allergic reaction promptly, before going to a hospital, reduces the risk of hospital admission and reduces the risk of needing more than one dose of epinephrine.
- Removing major food allergens from a diet to attempt to improve eczema carries some risk of an allergy to that food later.
- Supervising a teen to self-inject during an allergic reaction may improve the teen’s comfort with using an epinephrine auto-injector.
- Teens who experience a greater amount of support from peers, parents and teachers take fewer food allergy related risks.
- Consumers mistakenly believe precautionary allergen labeling (i.e. made on shared equipment or in shared facility) is regulated and they unfortunately assess risks based on the words used.
- Allergic reactions to egg, milk, or peanut during supervised oral food challenges and accidental ingestion do not boost IgE test results.
- Children with multiple food allergies, eczema, and other atopic conditions should be carefully monitored for health and growth.
Food Allergy Testing and Diagnosis
A food allergy diagnosis is dependent upon a combination of multiple factors. An allergist must work with their patients to understand their allergy history, details regarding past reactions, skin prick tests, blood tests such as specific IgE levels and component tests, and oral food challenges at the doctor’s office.
Children are more likely to outgrow their milk or egg allergies. There’s enough data available to predict the likelihood of a patient with milk or egg allergies outgrowing their allergies over time. The data is based on skin prick test results, blood IgE test results, or both. The Egg Allergy Resolution Calculator and Milk Allergy Resolution Calculator are available on www.cofargroup.org.
Risk Factors for Food Allergies and Potential Prevention
There are many risk factors associated with the increase in the prevalence of food allergies. It’s possible that because we live in very clean environments, our bodies’ immune systems don’t need to defend themselves from germs and pathogens. The Hygiene Hypothesis suggests that the immune system is essentially looking for a fight and reacts to food instead.
Other risk factors are low vitamin D levels due to a lack of exposure to sunshine. Dr. Sicherer also mentioned that an unhealthy diet and obesity are associated with an inflammatory state. How we process foods can also affect the food as a potential allergen. For example, peanuts have heat-stable oils, and roasting them increases their allergen potential compared to boiling them.
The timing of introducing food to an infant could also affect the risks of food allergies. Up until recently, medical professionals have taught families to avoid allergenic foods for infants, which may have increased the rate of food allergies. Recent peanut allergy research suggests that early introduction of peanuts for at-risk infants such as those with severe eczema, an egg allergy, or both may reduce the risk of food allergies. American Academy of Pediatrics (AAP) has developed guidelines to help medical professionals to determine an infant’s risk. After infants have been introduced to eating some solid foods and are developmentally ready for solid foods, there are three guidelines on how to introduce peanuts to consider depending on the child’s medical history.
- Infants with severe eczema, egg allergy, or both: They will need an allergist to provide a thorough evaluation in order to determine a plan on how and where to introduce peanuts safely at 4-6 months, possibly at home, a doctor’s office, or in a specialized clinic.
- Infants with mild to moderate eczema: Possibly introduce peanut containing foods around 6 months either at home or at a doctor’s office.
- Infants with no eczema or food allergies: They may introduce peanut containing foods as they would introduce other foods.
Treatment Strategies for Food Allergies
The goals of food allergy treatments are to help patients to tolerate a higher threshold of their allergen and to avoid potential side effects due to the treatment. Patients achieve desensitization rather than tolerance and current treatments are not considered a cure.
Desensitization treatments require regular exposure to the allergen. It’s a temporary state and protection from a severe reaction are affected by illness, exercise, menstruation, and/or pollen season. In contrast, tolerance would be considered a permanent treatment when it does not require regular exposure to the allergen, nor the regular use other medications, and is unaffected by illness, exercise, menstruation, or pollen season.
Here are news updates on several treatment strategies for food allergies. Do not try any of these potential treatment strategies without consulting a doctor first.
- Baked Egg/Baked Milk Oral Immunotherapy: Some studies indicate that 70-80% of children with milk or egg allergies are successful with baked milk or baked egg oral immunotherapy and are able to tolerate baked goods containing milk or eggs after treatment. Do not try giving children baked milk or baked egg products without a doctor’s supervision.
- Oral Immunotherapy (OIT): OIT has been studied for more than 100 years. The treatment is to increase the amount of allergen a patient eats gradually over time. Approximately 70-80% of OIT patients experience very large increases in their threshold of tolerance – possibly 1 or more grams. However, it is very common to experience side effects, including severe allergic reactions which are unpredictable. There is currently one peanut OIT study in phase 3 clinical trials.
- Sublingual Immunotherapy (SLIT): In this treatment, patients place a drop of a food allergen extract under their tongue every day. Even though it is a very low dose, exposure to 2 mg of peanut can improve a patient’s threshold to a more visible amount such as 1 peanut. Other than minor mouth itchiness, there are very few side effects. The increase in tolerance is not as robust as OIT, and not sustained without continued dosing.
- Epicutaneous Immunotherapy (EPIT): Patients apply a patch which is coated with a very low dose of allergen on their skin daily. There are few side effects with EPIT besides minor skin irritation. It’s not as robust of a treatment as OIT, but more effective than SLIT. The peanut patch is in phase 3 clinical trials, and the milk patch is in phase 2.
Dr. Sicherer concluded his session with hope and optimism. There are many ideas in the pipeline for further research, and he’s very grateful for clinical trial participants and their families who help advance food allergy research through their altruism. Dr. Sicherer’s attitude mirrored mine – excited for what’s to come with food allergy treatment and research, thanks to Food Allergy Research & Education.
To learn more about any of these topics, visit FARE’s website, and consult with your allergist for more information.
Sharon Wong blogs at Nut Free Wok – crafting allergen-aware asian fare. She is a food allergy mom, who uses her own experiences with recipes, cooking techniques, Asian ingredients, and food allergy-related awareness and advocacy issues, to help her blog readers navigate a nut-free life in a nut-full world.Originally posted July 2017